Wednesday, 16 February 2011

What would the AV mean for your health?

There has been much debate this week about the Alternate Vote system for future General Elections. The government will have a referendum on the matter where we all have our say. I do not wish to rehearse all the arguments for and against - these have been covered endlessly elsewhere - but simply to ask: "What effect, if any, would the introduction of AV have on our Health Service?"

Let us first consider the most basic fact. What would have happened to the make-up of parliament last May had alternate systems of voting been used? The above graph shows you the situation in all five of the proposed methods. A Coalition or minority government in each case with the Liberal Democrats (with possibly groups of minority/extremist parties in the case of full PR) as permanent kingmakers. Is this a good thing? Other European countries function perfectly well with successive coalitions and their health services have not necessarily suffered. The UK is however, in many respects, not Europe. Like it or not, policies that have encouraged us to emulate the Continent have not always worked - think 24-hour drinking/cafe culture.

Would the NHS, by then possibly with an independent NHS Board ostensibly outside direct political control, be much affected by changes in a government that had to accommodate more than one view? It is possible that future administrations might want to reverse this autonomy although it would be risky politically, given the degree of distrust that the public has for politicians tinkering with the service after the clumsy, shackling central target culture that characterised the Blair/Brown years. It is possible that future, more right wing governments might want to cut funding in favour of more involvement of the private sector (the seeds of this are starting right now). Having a centre-left balance might therefore not be a bad thing.

But overall, the NHS at 63 years of age, has a central place in the heart of the nation who will therefore not tolerate its dismantling and politicians do it at their peril. There will always be stories of mishaps - disasters even - as there will be in any health service in the world but underneath we know that we have it good. So good. As many people as live on these islands enjoying largely free and comprehensive healthcare remain uninsured in the USA.

So whilst the political landscape may change in other respects the NHS will remain relatively immune to changes in the voting system. So in the referendum, vote whichever way your conscience tells you. You'll still have a health service, free at the point of care.

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